The use of HBOT after AGE on
a 12 day old infant
Gas embolus and cardiac
arrest during laparoscopic pyloromyotomy in an infant.
Department of
Pediatric Anesthesiology, Children's Hospital of Wisconsin, Milwaukee, WI, USA,
sutaylor@mcw.edu.
Abstract
PURPOSE: High volume
tubing is used to deliver carbon dioxide during laparoscopic procedures.
Failure to prime the tubing with carbon dioxide prior to abdominal insufflation
may result in the delivery of nitrogen-containing air to the abdominal cavity.
We report a case in which initial insufflation of laparoscopic gas resulted in
immediate cardiovascular collapse requiring prolonged resuscitation. Persistent
intracranial emboli following the arrest may have resulted from nitrogen
contamination of the delivered gas. CLINICAL FEATURES: A 12-day-old female
underwent laparoscopy for pyloric stenosis. During initial insufflation of the
abdomen, the patient had an abrupt decrease in end-tidal carbon dioxide
(CO(2ET)) associated with bradycardia and pulseless electrical activity. Three
hours after successful resuscitation and open pyloromyotomy, computerized
tomography documented intra-arterial gas within the cerebral and hepatic
circulations that resolved following hyperbaric oxygen therapy. Magnetic
resonance imaging five days later revealed watershed infarcts in the right
frontal and parietal regions. Nitrogen, an insoluble gas not easily eliminated
from the body, was likely the gas present within the patient's circulation
several hours after the event. It was unlikely carbon dioxide, which is a
highly soluble gas that binds to hemoglobin and is rapidly buffered by the
carbonic anhydrase system and excreted by the lung. Room air contamination of high
volume insufflation tubing allows nitrogen to enter body cavities during
endoscopic procedures. CONCLUSION: Persistence of emboli following endoscopic
procedures suggests that the entrained gas is insoluble. Room air contamination
increases the potential for catastrophic events during laparoscopy and other
endoscopic procedures.
PMID: 20431981 [PubMed
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